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Friday, March 30, 2018

Overcoming Your Fear of Your So-Called "Negative" Emotions

In a prior article, Overcoming Fear of Anger, I discussed fear of anger and how psychotherapy can help.  But anger isn't the only so-called "negative" emotion that people often fear.  Aside from anger, many people fear sadness and grief.  There are also people who fear any strong emotion, including joy and happiness because of their history (see my article: Are You Afraid to Allow Yourself to Be Happy?).

Overcoming Your Fear of Your So-Called "Negative" Emotions

Why Are People Afraid of Experiencing "Negative" Emotions?
First, let me clarify that there's really no such thing as a "negative emotion," which is why I put quotes around the word "negative."  All emotions are normal.  It's what you do with your emotions that makes the difference.

So, I'm distinguishing feeling emotions vs. behavior.  If you get angry and you get violent, that's obviously a big problem.  But there's nothing wrong with feeling angry.  As I mentioned, it's what you do with it that matters.  Aside from getting violent, if you hold onto anger and resentment and, over time, you're unable to let go of these feelings, then this is a problem (see my article: Holding Onto Anger is Like Drinking Poison and Expecting the Other Person to Die and Letting Go of Resentment).

There is no one reason why people have fear of experiencing anger, sadness or grief, but for many people, it's about a fear of being engulfed or shattered by the emotion.  So, people with this fear often use various defense mechanisms to ward off what they consider unpleasant emotions.

Under optimal circumstances, children learn from their parents at a young age, in an age-appropriate way, how to deal with emotions that are uncomfortable for them.  If a child's parents are able to remain relatively calm when a child has a temper tantrum and help the child to calm down, the child learns that he can be angry; his parents aren't going to be angry with him because he's angry; and his parents will help him to calm down.

Conversely, if a child gets angry and the parents' reaction is to get angry too, then the child internalizes that his anger is "bad."  If the parents scold the child for having a temper tantrum and then isolate him in his room, this also gives the child the message that being angry is "bad" and he doesn't learn how to express his emotions in a healthy way.

Instead, the child learns that he has to hide his anger and not show it.  As a result, he grows up to be an adult who uses various defense mechanisms to defend against his anger and hide it from others and from himself.

Common Defense Mechanisms:
  • Denial: "I'm not angry." or "I never get angry."
  • Acting out: extreme behavior to express thoughts or feelings
  • Dissociation: zoning out and disconnecting from feelings
  • Projection: "I'm not angry--you're angry."
  • Rationalization: "Getting angry won't help me."
  • Intellectualization: Using intellect to disconnect from feelings
  • Regression: Going back to an earlier stage of development
  • Reaction Formation: Converting uncomfortable and unwanted feelings into the opposite feelings
and so on.

Temporarily Compartmentalizing Emotions vs Repressing Emotions
Warding off uncomfortable feelings indefinitely by using defense mechanisms is different from temporarily compartmentalizing feelings under particular circumstances.

For instance, if a manager is giving a presentation to senior managers and a thought crosses his mind about his father who recently died, he would want to wait until he had privacy to experience his emotions, so he would probably compartmentalize his grief and sadness temporarily until he had privacy to express them.  This would be a healthy coping strategy, and it's different from pushing down emotions indefinitely (How Compartmentalization Can Be Used as a Healthy Short Term Coping Strategy).

A Fictional Clinical Vignette: Overcoming Your Fear of So-Called "Negative" Emotions
The following fictional clinical vignette illustrates how psychotherapy can help a client to overcome fear of uncomfortable emotions:

Nina
Immediately after Nina's mother died unexpectedly, Nina got involved in a whirlwind of activities so that she almost always had something planned.  She feared that if she wasn't busy all the time that she would be engulfed by grief (see my article: Coping With the Loss of a Loved One: Common Reactions).

A few months later, Nina began getting headaches and she felt fatigued.  Her doctor ruled out any medical reasons.  When he asked her about what had been going on in her life in the last few months, Nina mentioned that her mother died unexpectedly.  She also mentioned that she was dealing with her grief by "keeping busy" most of the time (see my article: Are You Keeping Busy to Avoid Uncomfortable Emotions?).

When her doctor asked Nina if she allowed herself time to experience her grief, Nina was confused because she didn't understand why she would do that.  So, her doctor explained that grief is a normal reaction to losing a loved one and continuing to suppress her grief would be emotionally and physically unhealthy for her.

Overcoming Your Fear of Your So-Called "Negative" Emotions

He also told her that her headaches and fatigue might be the result of all this pent up emotion that she was suppressing.  Her fatigue might also be related to keeping herself constantly busy.  He recommended that Nina seek help from a psychotherapist.

Reluctantly, Nina began seeing a psychotherapist, who provided Nina with psychoeducation about grief being a normal and common reaction to the loss of her mother, and how psychotherapy could help her (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).

When her psychotherapist asked Nina about her family background, including how family members dealt with so-called "negative" emotions, like anger, sadness and grief, Nina told her that her parents would discourage her from being upset when she was a child.  They didn't like when Nina was sad and cried or got angry.  They would punish her.  So, Nina learned to suppress her emotions.

As they talked about Nina's discomfort with her feelings, Nina said, "I don't see how it would help me to allow myself to feel sad.  That won't bring my mother back."

Her psychotherapist explained defense mechanisms to Nina, and she spoke to her specifically about the defense mechanism of rationalization, which is the defense that Nina was using.  Then, she asked Nina if she was afraid of allowing herself to feel grief about her mother's death.

Nina thought about it for a few seconds, and then she said, "I guess I am afraid of feeling grief.  Sometimes, I can't help it--I just think about losing my mother and I cry, but I hate to cry and find some way to distract myself."

Over time, Nina and her psychotherapist worked to help Nina feel more comfortable with her emotions in a gradual way so that she didn't feel overwhelmed by them.  As Nina developed more of a tolerance for these emotions, she was able to allow herself to feel her grief (How Psychotherapy Helps You to Expand Your Window of Tolerance).

As Nina's ability to experience her emotions expanded, she felt relieved to experience her emotions rather than suppress them.  Her headaches and fatigue disappeared and, overall, she felt better.  She realized that emotions came in "waves" and her fear that she would be engulfed by her grief, as if it was a tsunami, was unfounded.

Conclusion
All emotions are normal.  What you do with your emotions is the real issue.

People who have a fear of experiencing their "negative" emotions usually don't learn as a child how to feel their emotions.  As adults, they continue to suppress what they consider to be uncomfortable emotions, these emotions are often somatized (i.e., the experiencing or expressing psychological problems in a physical way) with headaches, stomachaches, back pain, and so on.

Some people "medicate" their emotional pain by drinking excessively, abusing drugs, gambling compulsively and so on, in an attempt to shut down these emotions.

Even if someone didn't learn as a child how to experience uncomfortable emotions, she can learn how to cope with emotions in a healthy way in psychotherapy.

Getting Help in Psychotherapy
If you're struggling with emotions that make you feel uncomfortable, you can learn to experience your emotions in a healthy way in psychotherapy (see my article: The Benefits of Psychotherapy).

A licensed mental health professional can help you to deal with emotions that make you feel uncomfortable so that you're no longer using defense mechanisms or somatizing to ward off these emotions (see my article: How to Choose a Psychotherapist).

Allowing yourself to experience a full range of emotions can help you to feel alive, and it can add meaning to your life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome trauma and their fear of experiencing uncomfortable emotions.

To find out more about me, visit my website: Josephine Ferraro, LCSW -NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.





















Thursday, March 29, 2018

How Your Fear and Shame Can Lead to Avoidance in Therapy

When clients come to see me for an initial consultation in my psychotherapy private practice in New York City, I usually suggest that they give me a general idea of their presenting problem during that first session rather than getting into a lot of detail.  One important reason for that is that most people feel emotionally vulnerable during the consultation, and it can feel too exposing to them to get into a lot of details about their problems.  During that initial consultation, it's important for the client to see if she feels comfortable enough with me before she spends time revealing the depths of her problems, which could be shame inducing and anxiety provoking in the first session.

How Your Fear and Shame Can Lead to Avoidance in Therapy

If a client feels comfortable enough with me to come to subsequent therapy sessions, he can reveal more about himself.  For someone who feels ashamed of his problems, he can gradually reveal the areas of his life that might be causing him to feel ashamed.

As the client and I develop a more trusting therapeutic alliance, the problems that are creating shame for him usually emerge.  By then, the client has a sense that I've heard a lot as a psychotherapist of 20+ years and that it's unlikely he will bring up something that I haven't already heard about and helped other clients to overcome.

As the therapeutic alliance gets stronger and trust increases, a client usually feels more comfortable allowing himself to be more emotionally vulnerable with me.

But there are some clients who avoid talking to their psychotherapist about issues that they feel ashamed about even after they've been in therapy for a while and trust their therapist about most other issues.

Some of these clients unconsciously project their own negative feelings about themselves onto their therapist.  So, for instance, a client might blame himself and consider himself to be "a bad person" because he was sexually abused by a relative when he was a child (or for some other problem).  Rather than recognizing that he is the one who thinks he is "bad," he projects these disowned feelings about himself onto the therapist and tells himself that the therapist is the one who would think he was a "bad person" if he divulged the sexual abuse (see my article: Overcoming the Psychological Effects of Childhood Sexual Abuse).

It's unfortunate that there are clients who can go through an entire course of psychotherapy and never reveal certain things that cause them to feel ashamed.  In these cases, I'm not talking about things that  clients don't remember, which they can't bring up because they aren't consciously aware of these issues.  I'm referring to unresolved problems that they do remember.  These clients make an ambivalent decision not to talk to their therapist about these issues.  As a result, the therapy remains incomplete and the client doesn't get the help that he needs for this area of his life.

Fictional Clinical Vignette: How Your Fear and Shame Can Lead to Avoidance in Therapy 
The following fictional clinical vignette illustrates how fear and shame can be a hindrance with regard to addressing certain topics in therapy, and how a psychotherapist can address these issues in therapy:

Becky
Becky, a woman in her early 30s, began therapy to deal with anxiety that was affecting her in her personal life as well as in her career.

Prior to starting psychotherapy, Becky talked to her primary care doctor about getting a prescription for anti-anxiety medication.  Her doctor advised her to seek help in psychotherapy because he was concerned that, even though the medication would work to alleviate the medication, Becky would be reliant on the medication rather than learning coping strategies to alleviate the anxiety.  He also advised her that the medication could have side effects for her.  So, instead of prescribing medication, he referred her for psychotherapy (see my article: Medication Alone Isn't As Effective As Psychotherapy to Overcome Anxiety and Depression).

During the initial stage of psychotherapy, Becky focused on the anxiety she experienced in her dating life and at work.  Her psychotherapist taught Becky coping strategies that helped to alleviate the anxiety at work, but Becky continued to feel anxious when she went out on dates.

Becky told her therapist that even when she really liked a man that she dated a few times, she felt too anxious to continue seeing him.  She would usually make some excuse to discontinue seeing him.  Then, afterwards, she would feel frustrated and sad because she felt that she might never get into a serious relationship if she continued to allow her anxiety to cut short any possibilities with the men that she met and liked.

She explained to her psychotherapist that there was a part of her that very much wanted to be in serious relationship and eventually get married and have children.  But her anxiety about getting closer to a man outweighed her desire to be in a serious relationship, and made it impossible for her to develop a relationship.

She had never been in a serious relationship before.  All of her prior relationships with men were superficial.  Her fear was that if she continued to end things before she could develop a relationship, she would be alone and lonely.

During the initial stage of psychotherapy, when her psychotherapist asked Becky questions about her childhood history, Becky denied that she had ever been abused in any way.  But, as the therapy progressed, Becky became increasingly uncomfortable because she knew that she wasn't being forthcoming about her history of sexual abuse.

Even though she didn't tell her psychotherapist about it, Becky remembered all too well that when she was five years old, she told her mother that her maternal uncle was sexually molesting her.  At first, her mother didn't believe her.  She accused Becky of making up lies and punished her.  But then one day, when her mother left Becky in the care of the maternal uncle, her mother came home to find the uncle in Becky's bedroom on top of Becky on the bed.

Her mother was very upset and threw the maternal uncle out of the house.  She took Becky to the pediatrician and told him what she witnessed when she came home.  After examining Becky, the pediatrician told the mother that there were no signs of penetration.  Then, the pediatrician called the bureau of child welfare to report the case.  The pediatrician also recommended that the mother take Becky for counseling, which her mother never did.

After the doctor's visit, her mother told her that she was "evil" for allowing the uncle to molest her.  She said that Becky must have "seduced" the uncle and he wasn't to blame for what happened.  Instead, she placed the entire blame for what happened on Becky, who believed her mother and felt deeply ashamed.

Her mother also warned Becky that if Becky told the social worker from the bureau of child welfare what happened, she would be taken away and placed in foster care.  This frightened Becky more than anything, so when the social worker interviewed Becky, she told her that she made up the story about the sexual abuse.  Becky's mother also denied seeing anything when she came home.

After that, Becky's mother told her that she should never tell anyone about this or she would be taken away from their home.  Her mother also told her that they would never discuss it again (see my article: Breaking the Family Code of Silence in a Dysfunctional Family).

In the meantime, the mother didn't allow the uncle to come to the house anymore, but the mother didn't tell other family members what happened because she was ashamed that Becky "allowed" the sexual abuse.

As a result, Becky had to be around her maternal uncle at family gatherings where he would sometimes touch her inappropriately when no one was looking.  He told her that she should never tell anyone about it, and she didn't because she believed it was her fault.

Her psychotherapist, who had dealt with many clients who had unresolved childhood trauma, sensed that Becky was avoiding talking about childhood trauma.  She didn't want to push Becky to talk about it before Becky was ready, but she also knew that if Becky continued to avoid talking about any possible abuse, this would be an obstacle to Becky making progress in therapy.

One day, when her psychotherapist sensed that Becky was opening up more and she might be receptive, the psychotherapist told Becky that she had a sense that there might be something that Becky was avoiding discussing in therapy that might be related to her discomfort with men.  She said this in a empathic and tactful way to give Becky a chance to open up.

How Your Fear and Shame Can Lead to Avoidance in Therapy
At first, Becky hesitated and then she burst into tears.  After she calmed down, she admitted to her therapist that she was, in fact, holding something back because she felt so ashamed.  But, she said, she wanted to  begin talking about it because she felt it was related to her fear of getting closer to men.

Then, she told her psychotherapist what happened to her when her maternal uncle sexually abused her from the ages of 5-12, how her mother blamed her when she initially found out about the early abuse and didn't protect her when they were at family gatherings, and how she felt too ashamed to ever tell anyone about the abuse again, which continued for several years.

She also told her therapist that, as an adult, she knew objectively that she wasn't to blame for the abuse but, on an emotional level, she still blamed herself.

Once she revealed the abuse to her psychotherapist, she felt somewhat ashamed but she mostly felt relieved not to be holding onto this secret anymore.  They were able to talk about how fearful Becky felt about revealing the abuse to her psychotherapist.

She said that, even though she realized objectively that her psychotherapist had dealt with many clients who had been sexually abused and that her therapist wouldn't blame her for it, Becky still felt on an emotional level that her therapist might see her as being "evil," like her mother did.

The more Becky was able to talk about the sexual abuse with her psychotherapist, the freer and less ashamed she felt.  Eventually, they used EMDR therapy to help Becky overcome the trauma of the childhood abuse (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

As they worked on helping Becky to overcome the trauma with EMDR therapy, Becky began to feel more comfortable with men.

When she met a man that she really liked, she continued to date him to get to know him.  When she was ready to be sexual with him, she told him, somewhat shyly, that she had never been sexual with a man before.  She was afraid that he would laugh at her or think she was strange but, instead, he was understanding and patient with her, and their relationship eventually flourished.

Conclusion
During the initial stage of psychotherapy, it's common for clients to hesitate about revealing certain aspects of their lives, especially problems that cause them to feel emotionally vulnerable and ashamed.

The problem arises over time when clients avoid talking issues that are related to the presenting problem because they feel too ashamed to talk about it.  This hinders the therapy because the therapist isn't getting the full picture and, if clients continue to avoid talking about what they feel ashamed about, they don't overcome their shame.

When they're ready to talk about it, most people usually feel relieved after they've divulged what they've been avoiding.

Clients in therapy will often say that, after they reveal what they've been avoiding--whether it has to do with sexual abuse, problem drinking, body image problems or whatever the issue is, they feel a huge burden as been lifted from them.  Then, they and their psychotherapist can work directly on resolving the problem.

Getting Help in Therapy
Struggling on your own with unresolved problems can be frustrating and upsetting (see my article: The Benefits of Psychotherapy).

Developing a trusting relationship with a psychotherapist can take time, but once you develop a trusting relationship, a skilled psychotherapist can help you to overcome problems that are keeping you stuck, so you can live a more fulfilling life (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, you owe it to yourself to get help.

Once you're in therapy, even if you're not ready to completely open up about what's making you feel ashamed, it's important to talk to your psychotherapist to let her know that there's something you feel ashamed about that you're not revealing.  Then, at least, your psychotherapist will be aware that you're struggling with shame and that you need help to bring up whatever it is that you're avoiding.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome trauma.

To find out more about me, visit my website: Josephine Ferraro, LCSW -NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


























Tuesday, March 27, 2018

Who Would You Be If You Overcame the Problems That Keep You Stuck?

Have you ever thought about what your life would be like if you overcame the problems that keep you stuck?  Who would you be?  See my article: Overcoming the Fears That Keep You Stuck.

Who Would You Be If You Overcame the Problems That Keep You Stuck?

As I've mentioned in other articles, most people begin psychotherapy with some degree of ambivalence, even if they're not aware of it at first.  The ambivalence includes a wish to resolve their problems and make changes in their life and a wish to remain the same (see my article:  Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Although the ambivalence is usually there from the start of therapy, most clients don't become aware of it until after they're already engaged in therapy.  It can also become an obstacle once clients actually start to overcome their problems and make changes in their life.

Clients with longstanding problems often express being happy that they're making positive changes in their life, but they might also be concerned about what this means in terms of who they are--especially if they have a strong identification with their problems.  Losing that identification can feel like they're losing a part of themselves.

Fictional Clinical Vignette:
Who Would You Be If You Overcame the Problems That Keep You Stuck?

When Jim started psychotherapy, he was in his early 30s.  He told his psychotherapist that he felt like there was a "wall" between him and other people, even people that he had relatively close relationships with, like girlfriend (see my article: How Psychotherapy Can Help You to Gradually Take Down the Wall You've Built Around Yourself).

Back when he first started therapy, he described himself as coming across as outwardly warm, friendly and gregarious.  But, within his internal world, he often felt fearful of making close emotional connections with others.  He was able to hide his fear most of the time, but he was very aware of his emotional struggles.

Although he was aware in an objective sense that he had nothing to fear from his connections with his loved ones, on an emotional level his fear, at times, was overwhelming and it was interfering with his relationship.

Jim knew that he loved his girlfriend, but he would become anxious and ambivalent about the relationship, especially when his girlfriend talked to him about moving in together when they were together for two years.

He also knew that he couldn't keep making excuses as to why they shouldn't live together "yet." And he knew that if he didn't resolve his fear of getting closer to his girlfriend, he might lose her, so he began therapy to try to overcome his fear.

When he began therapy, he described his relationships with each of his parents as being fraught with problems.  His mother could be warm and nurturing at times, but she was often emotionally disengaged from Jim and his older siblings.  From day to day, Jim and his siblings never knew what kind of mood his mother would be in.

He described his father as "a great dad" who taught Jim how to swim and play baseball when Jim was a child.  Later on, his father taught him carpentry.  He and his father bonded over these tasks, and most of the time Jim enjoyed his time with his father.  The problem was that his father also had an unpredictable temper and Jim and his family never knew when the father would blow up.  His never got physically violent, but he could be scary when he lost his temper.

Then, the father would shame and belittle Jim and his siblings.  Their mother was just as frightened of the father when the father lost his temper, so she wasn't able to protect her children from her husband's rage.  At those times, Jim felt very alone and he would hide in his room, even when his father was angry with another family member.

As Jim continued to see his psychotherapist, they discovered together that Jim's fear of getting close was related to the unpredictable moods of each of his parents.  At a young age, Jim learned to shut down emotionally and built an emotional wall around himself to protect himself from feeling too emotionally vulnerable.

As a child, this worked to keep his fear compartmentalized so he could function in the rest of his life.  But as an adult, he realized in therapy that he not only walled off his fear, he also walled off other positive feelings.  He also realized that, as an adult in a relationship, he couldn't continue to allow his fear from getting closer to his girlfriend (see my article: When You Shut Down Emotional Pain, You Also Shut Yourself Down From Potential Pleasure).

At the start of therapy, Jim told his therapist that, even though he wanted to overcome his fear of intimacy, he wanted to work slowly in therapy because he was afraid he would become overwhelmed.    Also, like every client, he needed to take time to develop a therapeutic alliance with his therapist, and this was a gradual process for him because of his fears of opening up.

After two years in therapy, Jim worked through much of his early trauma related to his family using EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR Therapy and the Brain).

There were many times when Jim needed to use several sessions after one EMDR session in order to process what came up during the EMDR session and afterwards.  His therapist told him that each person processes differently, and this seemed to be what worked best for him.

With the childhood trauma resolved, over time, Jim was more open to getting closer to his girlfriend, who was patient with him.  He eventually moved with her, and he worked in therapy on the emotional challenges that he encountered once they were living together.

Progress in therapy often involved Jim taking two steps forward and one step back (see my articles:  Progress in Psychotherapy Isn't Linear).

Both Jim and his girlfriend both agreed that he had made significant progress in therapy, but they were also both aware that Jim continued to struggle in certain areas of their relationship.  After living together for two years, his girlfriend began speaking about getting married, which frightened Jim.

Periodically, Jim and his psychotherapist would review where he was in therapy as compared to how he was when he first came.  This was helpful to Jim to see his progress, especially when he felt emotionally stuck at a new level.

During one of these conversations with his psychotherapist, Jim told her that he was happy with the progress that he had made so far, but he was fearful of any further change.  He told her that he felt like he had "carried around" a particular sense of himself and that if he was no longer fearful of getting closer to his girlfriend, he wasn't sure who he would be.

His psychotherapist explained that this is a common problem for many clients in psychotherapy as they reach a certain point in therapy, and the timing is different for everyone.  Some people become fearful that they will lose their sense of self at the start of therapy.  For other people, like Jim, they become uncomfortable with who they will be when they are resolving the last remnants of their problems.

Working on the fear of losing his sense of self was much deeper work than Jim had ever done before.  Once again, Jim told his therapist that he wanted to go slowly now that he was at this new level of working through his problems.

His psychotherapist, who was a hypnotherapist and a psychoanalyst, helped Jim to navigate this fear in a way that felt comfortable for him (see my article: What is Clinical Hypnosis?).

Now that they were at this juncture in the work, his therapist used hypnotherapy to help Jim to imagine who he would be once his presenting problems were resolved--once he no longer feared getting closer to his girlfriend and he was able to take the next step in their relationship to get married, which was something that Jim wanted when he wasn't afraid.

Using imaginal interweaves, over time, his psychotherapist helped Jim to build his sense of self confidence.  Using imaginal interweaves provided Jim with an opportunity to imagine himself allowing himself to become more emotionally intimate with his girlfriend without the fear.

Who Would You Be If You Overcame the Problems That Keep You Stuck?

In other words, he was able to put aside his fear to use his imagination to imagine his future self in a loving relationship with his current girlfriend as his wife.  This "practicing" of his future self in his imagination gave him a felt sense of what it might be like not to be fearful.  And, after a while, Jim felt that he could go ahead and propose to his girlfriend without fear.

Conclusion
When people start psychotherapy, they're usually focused on the changes they want to make in their life.  It's only after they are either at the brink of making changes or actually making changes that some clients fear that their sense of self will change in a way that would be frightening to them.

Most of the time, these fears are rooted in a unresolved early trauma that needs to be worked out in therapy in order for clients not to continue to be triggered in the present (Coping With Trauma: Becoming Aware of Your Triggers and Reacting to the Present As If It Was the Past).

With the help of their psychotherapist, many clients are able to begin letting go of the fear related to the past to make progress in therapy.

As they reach new plateaus in their progress, there can be new challenges, as there was in the fictional vignette above where Jim was able to get relatively closer to his girlfriend, but felt the fear again as he thought about he getting even more emotionally intimate with her.

Hypnotherapy with imaginal interweaves can be especially helpful for the client to "practice" seeing his future self and getting comfortable with his new sense of self while his therapist maintains an emotionally safe and empathic treatment environment in the therapy sessions (The Creation of the Holding Environment in Psychotherapy).

Getting Help in Therapy
Change is a process.  At various points in the process, new challenges can arise in therapy, including a concern about who would you be if you overcame your problems (see my article: The Benefits of Psychotherapy).

Working with a skilled mental health professional who is licensed can make all the difference between succeeding or failing in your attempts to make changes and to do it in a way that feels safe to you (see my article: How to Choose a Psychotherapist).

If you're struggling with unresolved problems, you owe it to yourself to get help so you can free yourself from your history to live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome unresolved trauma.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.







Monday, March 26, 2018

Progress in Psychotherapy Isn't Linear

Clients who are new to psychotherapy often don't know what to expect, which is why it's important for psychotherapists to provide psychoeducation about how psychotherapy works (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).  One important aspect of psychotherapy to understand is that progress in therapy usually isn't linear, which is the topic of this article.

Progress in Psychotherapy Isn't Linear

Defining the Presenting Problem: Understanding Big T and Small T Trauma
It's understandable that clients want to see that they're making progress in therapy, especially if they've been suffering with longstanding problems.

When a client is in therapy, it's important for the client and the psychotherapist to understand the nature of the presenting problem.  That makes it easier to set therapy goals and to measure progress in treatment.  This might take a while to reveal itself as the client comes to therapy and gives the therapist information about the history of the problem and how it's affecting her now.

Usually, the narrower the problem, the easier it is to make progress and resolve the problem in therapy.  For instance, if a client comes to therapy after she has been robbed and, prior to the robbery everything was basically going well with no history of prior trauma, this is a simpler case than someone who comes to therapy with longstanding unresolved trauma from childhood (also known as developmental trauma).

Saying that it's a simpler case is in no way meant to minimize the traumatic experience of being robbed.  But compared to an adult client with a long history of being abused and neglected as a child, it's a less complex case.

With regard to definitions of trauma, the unresolved developmental trauma would be considered a "Big T trauma" and the one-time traumatic event, like getting robbed, where there was no prior trauma, is considered a "Small T trauma" (see my article: Big T and Small T Trauma).

For Small T trauma, the goals are usually more narrowly defined. These might include: The client being able to walk down the same street where she was robbed without fear or being able to leave the house without fear.  If someone who was robbed is very frightened, this is important and it might seem daunting.  But relative to Big T trauma, the scope is narrower.

For Big T trauma, the goals are more complex and might be multi-layered.  For instance, a client who was abused and neglected as a child might be fearful of experiencing his feelings.  He might have constricted affect and not even understand his feelings because he had to protect himself as a child so he wouldn't feel so vulnerable.  This, in turn, usually leads to problems in adult relationships.  So, you can see that Big T trauma is more complex, and there will be layers of trauma to work on.

Understanding the scope of the problem involves exploration.  For instance, a client might begin therapy by saying that she has a problem communicating with others.  This is, of course, a very general definition of a problem, and the psychotherapist would need to ask questions to make it more specific:  Does she have problems talking to everyone or only people at work?  Is the problem related to a medical issue or is it a psychological issue or both?  When did the problem start?  How does the client experience this problem?  How is this problem affecting the client internally and interpersonally?  And so on.

As the client and psychotherapist explore these questions and the history of the problem, they might discover that the problem is longstanding and the client cannot remember a time when she didn't have this problem, even as a child.

As they continue to explore this issue, they might discover that the problem is pervasive in all areas of the client's life.  The client reveals that all possible medical issues have been ruled out and the client's doctor recommended that the client seek psychological help.  Furthermore, the client reveals that whenever she has to speak, whether it's one-on-one or in a group, she becomes panicky and she has had a few panic attacks recently.

It soon becomes clear that the client's problem talking to others is a symptom of a much larger problem, and her anxiety is related to longstanding unresolved trauma.  As a result, the problem is much more complex than the client originally thought.  This sounds like Big T trauma, and it will require further exploration to discover the root of the problem.

In contrast to Big T trauma, if a client came to therapy and says she has problems speaking up at staff meetings ever since her boss humiliated her in a prior staff meeting, but she never had this problem before, she never has this problem in any other situation, and there is no developmental trauma, this is probably a Small T trauma.  It's not multi-layered like Big T trauma, and the goals in therapy would probably be narrower and more easily achieved.

The Circular Nature of Progress in Therapy
Even when a client has had a significant breakthrough in therapy in a prior therapy session, he might come in the next week experiencing many of the same problem that he did before the breakthrough.

You might ask:  "Why is this?"

Well, there are many reasons.  One reason is that many clients need at least a few "Aha!" moments in therapy in order for breakthroughs to stick.

Another reason is that, even when a client really wants to make progress in therapy and resolve his problems, there is almost always ambivalence and some anxiety about changing.  For many clients, the "devil" (or problem) they know is easier to deal with than the "devil" they don't know (change) (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Many clients will tell their therapists that they are fearful of who they would be if they didn't have a longstanding problem because they've had the problem for so long, and they've learned to identify with their problem as if it's a part of themselves.

As a result, a client might have to go over the same material several times or more before the change "holds" and remains.  They might have to circle back many times to rework the same or various aspects of the same problem.  Along the way, other aspects of the issues they're struggling with might come to the surface in order to get worked through.

This is one of the main reasons why progress isn't usually linear.  Most of the time it's circular:  Two steps forward and one step back.

For people who are in recovery for addiction, one of the first things that they learn in recovery is that relapse is part of the process.  Many clients new to recovery will hear this and say that they have made a firm commitment to their recovery and they will never relapse.  But being human means that clients often do go back a step or two before they can go forward.

It's no different for most other problems that people come to therapy to resolve.  And the more complex the problem, the more likely that progress will be circular and not linear.

Conclusion
Most clients who are new to psychotherapy expect that their progress will be a linear progression, like a straight arrow, where they keep making progress and never backslide.  But this is rarely the case, especially if their problems are longstanding and complex.

Understanding the problem, the problem's history, how it affects the client now, and so on, is important to setting therapy goals.  The simpler the problem, the easier it will be to resolve, so Small T trauma is less complex than Big T trauma and will be more readily resolved, all other things being equal.

Sometimes, the client either doesn't know what the problem is or thinks the problem is narrower than it is.  As the client and psychotherapist explore the problem, they can define the problem better to understand if it is a new problem which is narrow in scope or if it is a multi-layered problem with a long history, which makes it much more complex.

Assuming that clients come to therapy on a regular basis and they are working with a skilled psychotherapist, most clients' progress is circular rather than linear--two steps forward and one step back.  The more complex the problem, the more likely that clients will occasionally have setbacks (see my article:  Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).  This is human nature.

For more complex problems, if there is progress, it can usually be seen over time by comparing how clients were when they first started therapy to how they are feeling, thinking and behaving now.

With regard to making progress in therapy, knowing what to expect in terms of this going forward/occasionally going backward dynamic helps clients to have reasonable expectations of themselves and their therapy.

Getting Help in Therapy
Making a decision to change and asking for help in therapy are courageous initial step (see my article: Developing the Courage to Change).

If you have been struggling with unresolved problems, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to overcome your problems so that you can live a more fulfilling life, free from the history of your problems (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


















Sunday, March 25, 2018

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The two most prevalent forms of psychotherapy for trauma are "top down" and "bottom up" psychotherapy.  The focus of this article will be to distinguish between these two types of psychotherapy and how each approach works with trauma therapy.

What the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The Top-Down Psychotherapy Approach in Trauma Therapy
Top down psychotherapy is a form of psychotherapy that is most used in the US.  With top down therapy, the basic premise is that if you change how you think, you will change how you feel. 

In top down psychotherapy, like cognitive behavioral therapy (CBT), the psychotherapist helps you to see the distortions in your thinking and change your behavior.

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Top down psychotherapy focuses on the neocortex part of the brain, which is the part of the brain in charge of executive functioning.

One of the advantages of CBT is that it is easy to teach new psychotherapists.  It's not as complex as many of the experiential bottom-up approaches to therapy.

In my professional experience as a trauma therapist for more than 20 years, top down psychotherapy can work well for people under certain circumstances.  For instance, people who have phobias and who go for CBT often have good overcomes.

However, with regard to trauma therapy, I have found that many people don't overcome their traumatic experiences with CBT.  One important reason for this is that trauma therapy needs to focus on the limbic system in the brain where the trauma is stored--not on the neocortex, which is the focus of CBT.

I have found that when you focus on the neocortex in trauma therapy, the therapist can help the client to develop insight into their problems, but the trauma, which resides in the limbic system remains unresolved.

So, with CBT, the client has insight into the trauma, but nothing changes on an emotional level.  The client continues to be symptomatic for trauma.  In addition, the client is often confused as to why he isn't feeling better if he now has insight into his problem because he doesn't understand that insight isn't enough.

The Bottom-Up Psychotherapy Approach in Trauma Therapy
In the bottom-up psychotherapy approach in trauma therapy, there is more of a recognition of the importance of mind-body connection in resolving traumatic experiences (see my article: Mind-Body Oriented Psychotherapy).

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Bottom-up psychotherapy is also known as experiential psychotherapy (see my article: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

The bottom-up psychotherapy approach focuses on the limbic system of the brain where traumatic experiences are stored and where symptoms get triggered (see my articles: Coping With Emotional Trauma: Becoming Aware of Your Triggers).

Various forms of bottom-up psychotherapy approaches, which are experiential forms of therapy, deal with psychological trauma in different ways, and these include:

Somatic Experiencing focuses on the body discharging trauma-related energy through the body.  So, for instance, if someone is holding onto the trauma in the form of tension in her shoulders, the therapist might help the client to discharge this energy from the shoulders.  This usually happens in subtle ways (see my article: The Body Offers a Window Into the Unconscious Mind).

In EMDR Therapy (Eye Movement Desensitization and Reprocessing), there is a desensitization to the traumatic experience and a reconsolidation of the traumatic memories.  EMDR therapy posits that everyone is capable of adaptively processing information, including traumatic memories.   EMDR facilitates this processing (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Clinical Hypnosis, also known as hypnotherapy, posits that all hypnosis is self hypnosis (see my article: All Hypnosis is Self Hypnosis).  The psychotherapist who is a hypnotherapist facilitates the process of helping the client to achieve a relaxing state in order to make the connection between the mind and the body to change traumatic experiences.  This always the client's unconscious experiences to become conscious (see my article: Clinical Hypnosis: Bridge Back to Heal Emotional Wounds).

Conclusion
Over the years, I have used both top-down and bottom-up psychotherapy approaches to help clients to overcome traumatic experiences.

My experience has been that bottom-up psychotherapy approaches are more effective in helping client to overcome trauma than top-down approaches.

 I also want to emphasize that even when I use a bottom up approach to therapy, depending upon the needs of the client, I usually at least some top down form of therapy.

Getting Help in Therapy
The effect of traumatic memories often gets worse over time without psychological help (see my article: The Benefits of Psychotherapy).

If you have been struggling with unresolved trauma, you could benefit from working with a psychotherapist who uses a bottom-up approach to trauma therapy (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


Resources For More Information:
Awakening the Tiger - By Peter Levine, Ph.D. (about Somatic Experiencing)
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma - by Bessel van der Kolk, MD (about various mind-body oriented types of psychotherapy)
The Body Remembers - by Babette Rothschild, MSW (about the mind-body connection).
Healing Developmental Trauma - by Laurence Heller, Ph.D. (about neuroaffective relational model - NARM)
The Handbook of Hypnotic Suggestions and Metaphors - by D. Corydon Hammond Ph.D. (about clinical hypnosis)
Cognitive Behavioral Therapy: Basics and Beyond - by Judith S. Beck (about CBT)


Saturday, March 24, 2018

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

In prior articles, Anger as a Secondary Emotion and Boredom as a Secondary Emotion: Understanding the Underlying Emotions in Therapy, I wrote about anger and boredom in terms of secondary emotions.  In the current article, I will discuss focus on how understanding and expressing primary emotions could save your relationship.

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

Understanding Primary and Secondary Emotions in a Relationship
In a relationship where one person has an anxious attachment style and the other partner has an avoidant attachment style, each person will probably express their dissatisfaction and frustration with the relationship in different ways (see my article:  How Your Attachment Style Affects Your Relationship).

If one or both people in a relationship misunderstand what's being communicated, it could jeopardize the relationship, especially if both people are locked into a rigid, dysfunctional way of relating.

This is why it's so important to look beyond the surface of what's being expressed to understand the possible hurt and longing that is hidden beyond the surface.

Couples therapy with a licensed psychotherapist, who understands attachment styles and primary and secondary emotions, can help avoid misunderstandings and a possible breakup.

Fictional Vignette: How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship
The following fictional vignette illustrates how couples, who are locked into a dysfunctional interactive pattern, can learn to understand and express primary emotions by seeking help in couples counseling:

May and John
May and John, who were married for 10 years, decided to seek help in couples counseling because their relationship had devolved from a loving, nurturing relationship to an ongoing battle of accusations and counter-accusations.

May explained to their couples therapist that the problems began a couple of years ago when John took a new job where he had to spend a lot of extra hours at work.  When he came home, she said, he was exhausted, and all he wanted to do was eat supper, watch a little TV and then go to sleep.

She told the couples therapist that John was frequently asleep on the couch by 9 PM.  She said that, while she understood that he was tired from a long day at work, she often felt lonely because he was barely communicative during the week and when she wanted to go out on weekends, he just wanted to lounge around the apartment.

She also explained that whereas they used to have an active sex life, their sex life now was practically nonexistent.  Since they were only in their mid-30s, she felt this didn't bode well for the survival of the relationship.  She said that whenever she complained to him that he wasn't paying enough attention to her, he would remain silent and turn away from her, which infuriated her so much that she would lose her temper and begin yelling.

When he didn't walk into another room to avoid her, she said, he would sometimes also lose his temper so that they were then involved in a shouting match, both saying things that they regretted later.  Then, she said, they would usually each retreat from one another for a while--until the next argument and the cycle began again.

May said that they both wanted to have a child within the next year or so, but she didn't see how their relationship could survive.  So, on the one hand, it made her hesitant about having a baby and, on the other hand, she was aware that if she didn't have a baby soon, she might not be able to conceive because of her age.

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

The couples therapist noticed that while May was speaking, John sat silently looking away.  She could see that John was feeling annoyed and defensive, and he had "checked out" of the session as soon as May began speaking.

She would need to get to know May and John better over time, but her first impression was that, in terms of their attachment styles, May was in the role of an anxious "pursuer" and John was in the role of an avoidant "withdrawer" in their dynamic.

When the couples therapist invited John to speak, he shrugged his shoulders, "I don't know what to say.  May knows that I'm working these crazy hours in order to advance my career so we can eventually have a house and other things that we want.  It's not that I like working long hours--it's required of me.  Then, when I get home, I need space to breathe and relax, but I feel verbally assaulted by May as soon as I walk through the door.  All she does is nag me, which is such a turnoff so, yeah, I'm not usually interested in having sex because I'm tired but also because I'm turned off by how May speaks to me.  She's just so angry all the time.  It makes me feel like a failure as a husband.  Then, I just want to be alone.  Who wants to come home to an angry person who yells at you everyday?  Not me."

The couples therapist could see that May and John were locked into a rigid negative way of relating, and neither of them were able to express the love and longing that they felt for each other.  She started by reflecting back and paraphrasing what May said and included that it was clear that, underneath her anger and yelling, was love and longing (the primary emotions) to be with John.

May nodded her head and looked over at John, who seemed a bit more engaged when he heard the couples therapist express May's primary emotions, love and longing, that were being covered over by the secondary emotion of anger.  John looked over at May and took her hand.

Then, the couples therapist paraphrased what John said about actually wanting to spend more time with May, but being required to work long hours at the office.  She paraphrased how tired he felt when he came home and that he needed a little time to unwind before interacting with May.  She also paraphrased that when May got angry and yelled at him, he didn't know what else to do, he felt like a failure as a husband so he withdrew from her.  But, in fact, he really loved her and wanted to be with her (the primary emotions).

As John listened to the couples therapist, he nodded his head to indicate that this is how he felt.  Then, he smiled at May, whose demeanor had softened as she listened to the couples therapist paraphrase what John said.

Then, May squeezed John's hand and said to him that she would be more than willing to give him time and space when he got home if she knew that he would pay attention to her after that.  In response, John gave May a hug.

This was the beginning of weekly six month couple therapy where John and May learned about each of their attachment styles and the primary emotions underneath May's anxious anger and John's defeated avoidant withdrawal.

The beginning stage of couples therapy involved helping May and John to de-escalate their emotions.  May allowed John to unwind and, rather than expressing anger and criticism, she learned to allow herself to be vulnerable enough to express to John the love and longing that she felt.

When May allowed John time to unwind when he got home and she was no longer yelling at him, he felt more comfortable approaching May and being closer to her.  He understood that, even during those times when she would occasionally yell at him, that her anger was a secondary emotion that covered over her love and longing for him and her fears that he was emotionally abandoning her.

May also began to understand that John's withdrawal didn't mean that he didn't care about her.  It meant that this was his secondary, defensive emotion in response to her anger.  She realized that underneath his withdrawn demeanor, he still loved her, but he  felt emotionally overwhelmed by what he perceived to be her angry demands (see my article:  Relationships and Communication: Are You a "Stonewaller"?).

How Understanding Primary Emotions and Attachment Styles Could Save Your Relationship

They both realized that if they were going to repair their relationship, they each needed to make it safe for each other to be emotionally vulnerable enough to express their primary emotions. This wasn't easy because they each feared getting hurt.  But over time, they allowed themselves to express their primary emotions of love and caring and their relationship improved.

Conclusion
Secondary emotions usually cover over the core primary emotions, which is related to each person's attachment style.

The secondary emotion of anger, which was demonstrated in the vignette above with how May responded to John, often covers over hurt, fear and longing.  And what appears as nonresponsive withdrawal, demonstrated by John when May got angry with him, often covers over the primary emotion of fear and feelings of inadequacy.

In the role of the "pursuer" and with an anxious attachment style, May felt exasperated by John's nonresponsiveness so her anger escalated.  In response, John, who was the "withdrawer" with an avoidant attachment style wanted to withdraw even more.  Underneath what appeared to be a non-caring stance, John was fearful and feeling inadequate.

So, they were caught in this rigid negative dance with each other and neither of them knew how to change that dance until an empathetic couples therapist helped them by allowing them to see the love and longing behind their secondary emotions and feel safe enough to express their more vulnerable emotions (see my article: Relationships: Creating a Safe Haven For Each Other).

Getting Help in Therapy
The dynamics in the vignette that I presented above are common, and it's often very difficult for a couple to overcome these dynamics on their own.

A skilled couples therapist can help each partner to feel comfortable enough to de-escalate their emotions, understand their primary emotions (as opposed to the secondary emotions that are on the surface), and express their more vulnerable feelings of love and longing for each other (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

If you and your significant other are stuck in a rigid negative cycle, you could benefit from getting help from a licensed mental health professional who works with couples.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.

Self Help Resource:
Hold Me Tight: Seven Conversations for a Lifetime of Love - A Self Help Book About Emotionally Focused Therapy (EFT) for Couples by Sue Johnson.








Friday, March 23, 2018

Learning to Accept That You Can't Control Your Loved Ones

While it's understandable that you would want to spare your loved ones from experiencing pain or misfortune, if you try to control the lives of people close to you, you will need to learn what many other people have learned before you--you can't control anyone else's life.  Psychotherapy can help you to understand why you have a need to do this, help you work through the issues involved and to eventually accept that you need to focus on yourself (see my articles: When Someone You Love Rejects Your Help and Avoiding Codependency With Your Children).

Learning to Accept That You Can't Control Your Loved Ones 

If you think you can see clearly what a loved one needs and your offer to help is rejected, it can be a very difficult thing to accept.  Your intention, of course, is to help, but if your loved one doesn't want your help, you will need to back off--no matter how noble your intentions might be (see my article: Overcoming the Need to Be Everyone's Caretaker).

This can be especially difficult with close family members when you're anxious about their well-being and how they're living their lives.  But when your loved ones tell you that they don't want your help and they're of legal age and competent enough to make their own decisions, you could ruin your relationship by continuing to push.

I see many clients in my psychotherapy private practice in New York City who feel anxious and heartbroken that family members refuse to take their advice or allow them to help.  Their family members see their offer to help as being controlling behavior.

The more they try to help, the more their loved ones push them away.  In some cases, a family member can become estranged because of the strain of this dynamic.

Fictional Clinical Vignette:  Learning to Accept That You Can't Control Your Loved Ones
The following fictional clinical vignette illustrates this dilemma and how psychotherapy can help:

After Beth found out from her older daughter, Nell, that her 21 year old son, Rich, was abusing painkillers, she spoke to her son and offered to arrange to send him to a drug rehabilitation center.  Although Rich didn't deny that he was abusing painkillers, he was annoyed that his older sister divulged this information to their mother, brushed off his mother's suggestion and told her that he knew that he could stop on his own, without help, at any time.

In Beth's family of origin, her father and older brother both abused drugs and alcohol.  This caused Beth, her mother and Beth's siblings much suffering when Beth was a child.  Her father and brother both eventually got clean and sober when Beth was in her 20s, but their addictions precipitated a divorce between the mother and father and alienation with most other family members.

Since Beth's mother was incapacitated most of the time by her depression, as the oldest child, Beth assumed responsibility for her family at an early age.  By the time she was 12, she was cooking and cleaning for her family because her mother stayed in bed all day.  And sometimes Beth went to the local bar to find either her father or brother (or sometimes both) to bring them back home (see my article: Dynamics of Adult Children of Dysfunctional Families).

At the time, Beth didn't think this was unusual. She didn't understand that she was functioning as a parentified child.  She saw herself as being "strong" and able to handle whatever came up in the family.  At a young age, she felt she could resolve any family problem (see my article: Children's Roles in Dysfunctional Families).

Beth was the one, when she was in her early 20s, who arranged, at various times, for her father and brother to attend inpatient treatment.  When her father's primary counselor at the rehabilitation center explained the concept of codependency to Beth and recommended that she attend Al-Anon meetings, Beth dismissed this.  Her feeling was that she wasn't the one with the problems, so she didn't see why she should go to Al-Anon meetings.

When Beth couldn't persuade Rich to go to inpatient treatment, she asked her father to come speak with Rich.  By this time, her father had over 20 years of sobriety and he was still active in the 12 Step community.  He spoke with Rich one-on-one and tried to persuade him to get help, but Rich was angry that his mother told his grandfather about his addiction, and he stopped talking to Beth.

Beth worried about Rich night and day.  She hardly slept.  She blamed herself for divorcing his father, who was an active alcoholic who broke contact with Beth, Nell and Rich.  She thought about all the things that she "should" have done to prevent her son from getting addicted to painkillers, and she continued to try to persuade him to get help--to no avail.

Several weeks later, Beth received a call from the police that Rich was in a car accident and he was arrested for driving while impaired.  He explained that her son was taken to the hospital where he would be medically evaluated and and evaluated for a detox.

After Beth got off the phone, she was so upset that she was shaking.  She blamed herself for not doing more for Rich.  She felt she could have prevented this accident and arrest, but she wasn't forceful or persuasive enough.

At the hospital, she found out that, aside from minor bruises, Rich wasn't seriously injured and no one else was hurt.  The doctors told her that it would take about 10 days or so to detox Rich from the painkillers.  During that time, Beth hired an attorney, who recommended to Rich that, as soon as he was able, he go to a drug rehabilitation center to deal with his addiction and to show the judge that he was serious about getting clean.

Rich completed the hospital detox and a 28 day stay at a rehabilitation center.  Since it was his first offense, the judge agreed that Rich should go to rehab and a court representative would monitor his treatment.

While he was in rehab, Beth and Nell went to visit him twice.  They met with the primary counselor, who recommended Al-Anon for them.  Both Beth and Nell scoffed at the idea.

Following inpatient treatment, Rich attended outpatient treatment and he went to 12 Step meetings with his grandfather.  Eventually, he obtained a sponsor and he began to turn his life around.

Even though Rich was doing much better, Beth continued to relive the moment she received the phone call from the police officer.  She ruminated about how her son could have been killed in that car accident and she blamed herself.  This went on for months, until finally, Beth's best friend, who listened to Beth blame herself over and over again, recommended that Beth seek help in therapy.

Normally, Beth wouldn't even consider attending psychotherapy, but she knew she needed to do something, and she didn't know what else to do.  She was a nervous wreck, and she couldn't sleep.  So she contacted a psychotherapist to begin therapy.

Learning to Accept That You Can't Control Your Loved Ones

After Beth told her psychotherapist about Rich's addiction, how she tried to help him and how guilty she felt, about the car accident and her family's history with addiction, Beth's psychotherapist explained to Beth that her traumatic family history was getting played out with her son.  She told Beth that she functioned as the family rescuer in her family of origin and she was trying to function in that same role with her adult son, but it wasn't working.

Her psychotherapy explained the concepts of codependency to Beth and helped Beth to make connections between her family history and her current situation with Rich.  She also explained to Beth that she functioned as a parentified child in her family because neither her mother or father were able to function as parents.

As Beth listened to her psychotherapist, she realized that this all made sense, but she didn't know how to stop trying to control her son.  She explained to her psychotherapist that, even though he was randomly tested at his outpatient program, all his tests were negative and he seemed to be doing well, she continued to try to monitor his behavior.  She worried whenever he went out and she was vigilant for any signs of a relapse.  This created tension between Beth and her son, and he told her that he planned to move out with sober friends as soon as he found a job.

Beth's psychotherapist recommended that Beth start focusing on herself, specifically learning to de-stress with meditation and breathing exercises that her psychotherapist taught her.  She also recommended that Beth work on her unresolved childhood trauma with EMDR therapy (see my articles: What is EMDR Therapy? and How EMDR Therapy Works: EMDR and the Brain).

Beth had little confidence that her psychotherapist's recommendations would work, but she didn't know what else to do, so she practiced the meditation and breathing exercises.  She also began taking a yoga class and she developed a wind down routine to sleep better.

When Rich told Beth that he found a new full time job and he had plans to move in with sober friends, she became highly anxious.  When she saw her psychotherapist, she fretted that if Rich moved out, she wouldn't be able to monitor how he was doing and she would worry all the time.

Her psychotherapist was empathetic towards Beth.  She understood that Beth was experiencing anxiety about the current situation and her history of family trauma with two addicted family members was also getting triggered.

By the next session, Beth and her psychotherapist began processing her recent traumatic experience with her son's addiction to help Beth's mind and nervous system to get caught up with the fact that her son was actually doing well and she was the one who was still stuck at the point when she found out that her son was abusing painkillers.

Over time, EMDR therapy helped Beth to "update" her emotional experience with her son.  Before doing EMDR, Beth knew objectively that her son was sober and he was doing much better.  But on an emotional level, she was still stuck back in that moment when Nell told her that Rich was abusing painkillers and also in the moment when she got the call from the police officer.

After doing EMDR therapy, over time, Beth gradually worked through her traumatic family history.  She felt compassion for the young child that she had been when she was taking on adult responsibilities for her family.  She could look back now and realize what an impossible task that was and what a toll it took on her emotionally.

Learning to Accept That You Can't Control Your Loved Ones

After Beth worked through her history of trauma, she and her psychotherapist tackled her current worries about her son.  Having worked through the earlier history of trauma, working on her feelings about her son was, although not easy, easier than she would have expected.  She was able to know and feel that Rich was doing better.  She told her psychotherapist that she could now feel the uselessness of her worrying (see my article: Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

She also felt and accepted on an emotional level that she couldn't control her son or anyone else--she could only control herself.  Although this made her feel sad in a way, she said she also felt relieved because she knew there was nothing for her to do now.

Beth continued to focus on herself.  She eventually went to Al-Anon meetings to get group support to help her not to backslide.

After she stopped trying to monitor Rich's behavior, Beth and Rich got closer and they were able to repair their mother-son relationship.

Conclusion
Accepting that you can't control your loved ones' life can be one of your biggest challenges, especially if you grew up being a parentified child as in the fictional vignette above.

You can offer your loved ones love and emotional support, but you can't live their lives for them or try to control what they do.

By focusing too much on your loved ones' problems, you not only risk alienating them, but you also risk neglecting yourself.

Sometimes, you have accept that your loved ones can do what's necessary to take care of themselves when they're ready.

Getting Help in Therapy
If you try to control your loved ones' behavior, you might have a long history of trying to rescue family members in your family of origin.  If you were successful in rescuing family members, you might really  believe you can also control loved ones in their current life.  If you were unsuccessful in rescuing family members, you might feel compelled to "get it right this time" in your current situation.

Trying to control loved ones when they reject your help, as in the scenario above, is counterproductive and the situation tends to spiral down.

A skilled psychotherapist can help you to overcome codependency issues so that you can stop trying to control what you can't control and focus on taking care of yourself (see my article: The Benefits of Psychotherapy).

A trauma therapist can help you to overcome trauma related to the current situation as well as unresolved trauma related to the past (see my article: How to Choose a Psychotherapist).

Once you accept that you can't control anyone else and learn to let go, you can feel freer and live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.